Xgeva

Correct hypocalcemia before starting; ensure adequate daily calcium, magnesium, and Vit.D intake, esp. in renal impairment (CrCl <30mL/min). Monitor calcium (esp. 1^st weeks of initiating), phosphorus, magnesium levels and Vit.D intake in susceptible patients (eg, severe renal impairment, receiving dialysis). Risk of osteonecrosis of the jaw (ONJ) in diabetes, gingival infections. Perform oral exam and preventive dentistry before and regularly during therapy. Maintain good oral hygiene. Avoid invasive dental procedures during treatment; consider temporary discontinuation if procedure is necessary. Evaluate for atypical fractures if thigh/groin pain develops; consider withholding therapy until risk/benefit assessment. Monitor for hypercalcemia after treatment discontinuation in patients with giant cell tumor of the bone and patients with growing skeletons. Risk for or history of osteoporosis or prior fractures: increased risk of multiple vertebral fractures after discontinuing treatment. Embryo-fetal toxicity. Advise females of reproductive potential to use highly effective contraception during therapy and for at least 5 months after last dose. Pregnancy; exclude status prior to initiation. Nursing mothers (impaired mammary gland development/lactation in animal studies).

Correct hypocalcemia before starting; ensure adequate daily calcium, magnesium, and Vit.D intake, esp. in renal impairment (CrCl <30mL/min). Monitor calcium (esp. 1^st weeks of initiating), phosphorus, magnesium levels and Vit.D intake in susceptible patients (eg, severe renal impairment, receiving dialysis). Risk of osteonecrosis of the jaw (ONJ) in diabetes, gingival infections. Perform oral exam and preventive dentistry before and regularly during therapy. Maintain good oral hygiene. Avoid invasive dental procedures during treatment; consider temporary discontinuation if procedure is necessary. Evaluate for atypical fractures if thigh/groin pain develops; consider withholding therapy until risk/benefit assessment. Monitor for hypercalcemia after treatment discontinuation in patients with giant cell tumor of the bone and patients with growing skeletons. Risk for or history of osteoporosis or prior fractures: increased risk of multiple vertebral fractures after discontinuing treatment. Embryo-fetal toxicity. Advise females of reproductive potential to use highly effective contraception during therapy and for at least 5 months after last dose. Pregnancy; exclude status prior to initiation. Nursing mothers (impaired mammary gland development/lactation in animal studies).